Predictors of Atrial Fibrillation Development in Patients With Embolic Stroke of Undetermined Source: An Analysis of the RE-SPECT ESUS Trial
| Autor: | Bahit, Maria Cecilia, Sacco, Ralph L., Easton, J Donald, Meyerhoff, Juliane, Cronin, Lisa, Kleine, Eva, Grauer, Claudia, Brueckmann, Martina, Diener, Hans Christoph, Lopes, Renato D., Brainin, Michael, Lyrer, Phillippe, Wachter, Rolf, Segura, Tomas, Granger, Christopher B., Lyrer, Philippe |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Medizin MEDLINE Administration Oral Body Mass Index Double-Blind Method Predictive Value of Tests Recurrence Risk Factors Physiology (medical) Internal medicine Atrial Fibrillation Natriuretic Peptide Brain medicine Humans In patient Stroke Aged Embolic Stroke Aspirin business.industry Age Factors Models Cardiovascular Atrial fibrillation Middle Aged medicine.disease Peptide Fragments Embolic stroke Dabigatran Hypertension Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 144(22) |
| ISSN: | 1524-4539 |
| Popis: | Background: A proportion of patients with embolic stroke of undetermined source have silent atrial fibrillation (AF) or develop AF after the initial evaluation. Better understanding of the risk for development of AF is critical to implement optimal monitoring strategies with the goal of preventing recurrent stroke attributable to underlying AF. The RE-SPECT ESUS trial (Randomized, Double-Blind Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate Versus Acetylsalicylic Acid in Patients With Embolic Stroke of Undetermined Source) provides an opportunity to assess predictors for developing AF and associated recurrent stroke. Methods: RE-SPECT ESUS was a randomized, controlled trial (564 sites, 42 countries) assessing dabigatran versus aspirin for the prevention of recurrent stroke in patients with embolic stroke of undetermined source. Of 5390 patients enrolled and followed for a median of 19 months, 403 (7.5%) were found to develop AF reported as an adverse event or using cardiac monitoring per standard clinical care. Univariable and multivariable regression analyses were performed to define predictors of AF. Results: In the multivariable model, older age (odds ratio for 10-year increase, 1.99 [95% CI, 1.78–2.23]; P P =0.0304), diabetes (odds ratio, 0.74 [95% CI, 0.56–0.96]; P =0.022), and body mass index (odds ratio for 5-U increase, 1.29 [95% CI, 1.16–1.43]; P 2 DS 2 -VASc (stroke risk score based on congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, previous stroke, transient ischemic attack or thromboembolism [doubled], vascular disease, age 65 to 74 years, and sex category [female]) scores, and higher scores were associated with higher rates of developing AF. Conclusions: Besides age, the most important variable, several other factors, including hypertension, higher body mass index, and lack of diabetes, are independent predictors of AF after embolic stroke of undetermined source. When baseline NT-proBNP was available, only older age and elevation of this biomarker were predictive of subsequent AF. Understanding who is at higher risk of developing AF will assist in identifying patients who may benefit from more intense, long-term cardiac monitoring. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02239120. |
| Databáze: | OpenAIRE |
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